Suitcase

I bumped into it in the throes of a paroxysm of house cleaning and purging back in a dusty corner in my office. It was actually still in the cardboard box it came in. Leather-bound, and still handsome after, what? Maybe 70 years? The scuffs and the sprung latch on the right side are the legacy of my dad’s many train trips to Philly, to Johnstown, to New York and Jersey. It was never really big enough for a week away from home, but it was what he could afford. He had to stuff his things in there and sit on it to close it, which explains the latch.

I wiped the dust off it, and placed it gently on the bed, and Charlie was there with me for a moment. The tears just poured down my face. It was 46 years ago, right around this time of year, and the hurt is still there. He was such a good guy, such a kind and warm man, such a great father, and he was only 54. Why in the name of God did that have to happen?

Almost exactly a year ago, I damn near died. The experience has been transformative, as I guess it is for many people who have had a confrontation with the hereafter. I have spent the last 12 months making some big changes in my life, and I have learned or rediscovered a good many things. I know how much I’m cared for. I know how many calories are in a 12 ounce beer. I know what’s important to me and what is less so. I know how to do a good dead lift and a decent push-up. I have learned to be much happier, with much less. I have learned to be grateful. Maybe the most important lesson, for me at least, has been about time.

I brood on the past. It’s inherent in my profession, in my interests, in my nature. I tend to view current events, both public and personal, through the lens of history. In the last year, I’ve gotten much better at making peace with all that water under the bridge. The value of history is in what it can teach you, not in second-guessing it. What you owe to the dear and departed is your love, not your longing. Your mistakes and misfortunes can be instructive or they can be regrettable, but you get to decide which. In the very short time that we all spend here on this earth, your past can be your inspiration or it can be a short chain that binds you in darkness. As I learned, it can actually kill you.

So I prefer now to look forward. This day, every day, is a gift, a chance to learn, to be kind, to take delight. There are a limited number of them. What I owe myself, what I owe this world, what I owe all the folks who love me and cared for me and saved my life, is my best effort on every one. What will matter when I’m gone is the good I do, the kindness I show, the folks I can teach and help and care for, right now. The tragedies and mistakes of my past can stay there, I don’t have time for them anymore.

What I most want to recall about Charlie isn’t his early death, but him. I remember his laugh, his big voice and his boundless sense of humor, his kindness, his ready willingness to volunteer and to help anyone with anything. I was lucky beyond imagining that I had him in my life.

When I opened Charlie’s suitcase I found it empty, and I closed it again, and I put it away in a safe palace. The tears passed as suddenly as they had come.

I wish you all the Happiest Holidays imaginable…

307

Montana: A Beginner's Guide

The following story first appeared in a regional literary magazine here in Central Pennsylvania back in the early 2000's. I actually wrote it back in the 90's. I often share it with young friends who are heading west for the first time. Enjoy yourselves...

MARCH: A Long Way from Home

I got on an airplane in Baltimore, at 7:30 AM on a March morning in 1980 to take a seasonal job with one of the large Federal land management agencies that own most of the Northern Rockies. It was foggy and about 50 degrees. I debarked in Butte at about 3:00 PM, where it had warmed all the way up to 15 below zero after a nighttime low of 25 below. After a two hour ride with my new boss, we arrived at a tiny outpost of the Federal Government about 16 miles from the Continental Divide and 12 miles from a town of 200 people. Only the main road was paved in that town, the rest of the streets were gravel. It was ten degrees colder there than it had been in Butte.

The next morning when I opened the blinds on the window of the bunkhouse I was assigned as quarters, there was a coyote standing on a snowdrift maybe 10 feet from the window. He looked up when the blind opened, and we stared at each other through the window for almost half a minute. He was so close I could see his nostrils dilate as he strained to catch my scent. Presently, he cocked a leg in my direction, and trotted away at a dignified pace into a landscape full of gigantic mountains and endless snow. You could see him for almost half an hour, until the white distance simply swallowed him up.

I was 24, and I had never been west of Pittsburgh.

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APRIL: Regarding Domestic Life

During the first five weeks of my residence, our little combination Ranger Station/Visitor's Center had no visitors. None. Zero. I was busy though. Abe, my boss, and Larry, the maintenance man, both had duties that took them to half a dozen other similar facilities scattered over an area the size of, say, western Connecticut, so most day to day tasks fell to me, the only permanent resident. Since it snowed at least a little nearly every day during those first weeks, I had a fairly predictable schedule that involved plowing the driveway and parking area clear with a small snow plow mounted on a green government truck that was older than I was. After plowing I'd shovel the walks, and sometimes the roof if there was a lot of snow. By then, it would be time to plow the drive and parking area again, and so on....

Actually, I should revise my description of the April visitation rate to no tourists. Local people dropped in from time to time; we had heat and a coffee pot. There were two brothers, twins named Bart and Bob Miller (not their real names), somewhere on the long side of 35 years old, who visited regularly. In many ways they were typical native sons, but they weren't like anybody I'd ever met in Pennsylvania. They didn't seem to actually have jobs per se, yet they were the busiest people I'd ever met.

Between them, they drove the county snow plow and the school bus, they did some logging, primarily for poles and firewood, they built jack-leg fences and Beaver-slide hay derricks and log houses, they dug and cleaned irrigation ditches, they ran some cows of their own and for other folks as well, they bought, sold, and worked on pickup trucks, they guided hunters, they helped to make hay on several of the big ranches in the area. Bob was an amateur veterinarian, farrier, and castrator of calves, which is, evidently, something of an art form. Bart was rumored to have a small still somewhere up on the National Forest that was fired with lodgepole pine, and was said to produce something you could both drink and thin varnish with. As I was an ignorant eastern kid, both brothers felt a sort of moral duty to educate me.

One of the first things you noticed about these guys was their domestic status. In a state where, at least at the time, males outnumbered females about two to one, both of them were married to exceptionally handsome women. Bart's situation was especially odd. Although he was widely known as a reprobate of the first order, his wife, Betty, was a devout Mormon, and they lived under the same roof with her parents and brothers. Her father was a bishop. After I got to know Bart well enough to ask about his and Betty's arrangement, he provided me with the following explanation.

As he told it, they had gone to dinner over in Anaconda a couple of times, and after several such dates, he finally screwed up the fortitude to make a pass at her in the cab of his truck, a pass she responded to with considerable enthusiasm. Before things got too far along, he made a discrete inquiry regarding precautions against pregnancy. She told him she was taking birth control pills.

Now he must have thought it odd that the 20 year old only daughter of a Mormon bishop from a town of 200 people had such a prescription, but he didn't find it odd enough to ask too many questions.

Maybe six weeks later, in the middle of an otherwise quiet Sunday, he answered a knock at his door to find her father and two of her brothers smiling at him through the screen door.

They were dressed for church, scrubbed, shaved, grinning cheerfully from ear to ear, and bristling with firearms. They invited themselves in, and explained to Bart the peculiar and time-honored Mormon belief in posthumous conversion, wherein a sinner, no matter how vile his wickedness, could be saved and brought to know God even after that sinner had actually left the corporal world. The wedding was held a week later in Butte, and Bart was welcomed into the bosom of the family.

"My God, Bart, you must have guessed she wasn't on the up and up!" “Well, yeah, I sorta did, but think about it. I didn't get shot, and they didn't make me convert, so I ain't posthumous or a Goddamned Mormon. I got a good place to live, all the relatives a guy could want and three beautiful kids. Betty is still one of the prettiest women in the whole county, and hell, every mother's son needs to git the dust blowed outta his pickle every once in a while! I think I done OK, depending on how a guy wants to look at things."

Alright, it ain’t Socrates nor Descartes, but it is philosophy, or at least it's philosophical. He and Betty seemed happy enough, and who are we to judge?

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MAY: On Independence

To live in the most remote parts of Montana, you have to be able to take care of yourself. If something bad happens to you way back in the pucker brush, nobody is likely to come along and find you, and you might die. It's not that Montanans don't help each other out, most of the ones I know are among the most cooperative and openly friendly people I've ever met anywhere, but in the 1980’s there were only about 800,000 of them. The state is three times the size of Pennsylvania. There's just not a lot of them around.

Bob Miller was sawing down a lodgepole in cold weather during the first week of May, miles back off some Godforsaken logging road on the National Forest. Sometimes if there's a cold snap after the first warm spell of spring, the sap will start flowing in the trees, and then freeze. If you cut a tree in this condition, it may behave unpredictably. The tree slipped off the stump and came straight down, butt first, on Bob's left foot. The whole damned tree. His foot was, of course, broken to pieces. He smoked a cigarette, tightened his boot laces as much as possible, and drove himself 77 miles to the hospital in Anaconda. He did this in a truck with a manual transmission.

Think about that.

In such a place and under such circumstances, independence is not conceptual. It is reality and it is mortal as hell.

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The need for self reliance brings with it some other things that make Montana what it is. Hand in hand with independence comes a philosophy that espouses tolerance. The feeling is, if folks demonstrate that they can take care of themselves and aren't bothering anybody, then they have a right to live, think, and act as they see fit. At its best the independent and accepting disposition of Montana has fostered a kind of live and let live tolerance of all kinds of people, a tolerance that has drawn gifted writers, artists, and thinkers to the state and given it a lively and Bohemian creative life completely out of proportion to its tiny population and distance from the big coastal centers of the arts. At its worst, this is the same tolerance that has allowed the Freemen, and other less well known groups of hateful people, to flourish, the same acceptance that allowed Ted Kaczynski to live a quiet life near Lincoln for years without anyone ever wondering or asking what the hell he was up to. Montana is a monument to both the possibilities and pitfalls of absolute personal freedom, a paradox that most Montanans recognize and try to come to terms with.

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Bob Miller made it to the hospital, and the doctors pinned his foot together, put a huge fiberglass cast around it, and managed to save it. Two weeks later, he drove back to the scene of the injury, wrapped a plastic bag around his cast, got out his chainsaw and buzzed up the lodgepole that smashed his foot. When he got the pieces home, he split them up for cordwood. …………………………………………………………………………………………………

JUNE: The Arsenal of Democracy

In the early 1980's there weren't a lot of satellite dishes or TV cable companies in the most rural parts of the Intermountain West, so where I lived, real-time broadcast news of the outside world mostly came by way of a powerful AM radio station out of Butte. The music they played was awful and no one ever turned it on. Thus many of us out in the hinterlands were mighty surprised that early June day when the sky got just about pitch black at noon time, and a fine gray substance began to rain down on us. Of course we all assumed a nuclear exchange had occurred.

There were lots of documentaries in those days about the impending nuclear crisis, and Montana, thanks to its low population density and abundance of federal land, contains uncountable ICBM silos. The thinking in Washington is, by locating the nukes in the western boonies, you minimize the "incidental losses" if your "assets" are "targeted". What this Washington-speak actually means is, in the event of a nuclear war, the deadest people will be in Montana, Idaho, Utah, Nevada, Wyoming and the eastern parts of Washington and Oregon. Bart Miller's response to all of this was to stop his truck as often as possible at the chain link gates of any silo he happened to come upon in his travels, and take a leak in full view of the silent but watchful camera that stood sentinel at the entrance. I have always assumed his FBI file to be quite entertaining and extensive.

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There is a deep resentment of the Federal Government throughout the Rocky Mountain States, a resentment no easterner can truly appreciate. Their populations are low so they have little influence in Washington. The federal government is generally the biggest landowner in the state, doesn't pay taxes, doesn't have to obey local and state ordinances and laws, and most local folks depend on it for lumber, firewood, game, fish, grazing, jobs, minerals, irrigation and drinking water, and other things. Most Rocky Mountain natives feel like they should have some considerable say in how Federal Land gets used, since its use affects them dramatically and disproportionately. For better or worse, Uncle Sam has assumed the role of a hated absentee landlord in much of the west, and using the region as a place to stockpile weapons of mass destruction and toxic waste, as if nobody lives there, hasn't helped matters.

Of course, the "sagebrush rebellion" and "wise use" types, who simply want carte blanche to do whatever the hell they want to with Federal Land, and have been threatening to shoot at Federal Employees lately, aren't much of an alternative to a monolithic Big Brother. Mining-caused Superfund sites, 3600 acre clearcuts, severe overgrazing, and the de-watering of entire drainages have been some of the by-products of Federal acquiescence to local demands. This acquiescence has been generally lubricated by the none-too-subtle bullying of extractive industries and the elected officials from the region whose campaign chests are subsidized by these industries. Like it or not, there's no good evidence that local people and business interests manage land or resources any better than the "faceless bureaucrats".

What is needed in Montana, and all over the Intermountain West, is a better way to manage public land; a paradigm that responds to local interests and national priorities in something like a balanced way, and does so with a little grace and respect for the land and the folks who manage it, and live near it.

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To the relief of all in the vicinity, the gray stuff proved to be a stray volcanic ash cloud from Mount Saint Helens, and harmless. After several hours of nail-biting uncertainty, I joined quite a group of folks decompressing from the scare in the local gin mill. Bob Miller, deep in his cups, stood up at the table, stomped his huge cast on the floor to get everyone's attention, and roared out his contention that Montana should secede from the Union. His embarrassed wife Joanne tugged on his arm trying to get him to sit down, and hissed "Christ Bob, shut up! You're drunk. We can't win a civil war!" Bob glared at her, weaving a bit and struggling to balance and focus, "Why not? We got all their goddamned missiles!"

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JULY: Ignorance and Enlightenment

In early summer, I was joined by another seasonal employee, inflating our full-time staff to two, and bringing another kid from "back east" to the mountains. George Nylund (again a pseudonym) was from Minnesota, which to many Montanans is "Back East", and was, like me, in his early 20's. As it turned out, he had even more to learn than I did.

George drove straight through from Duluth to start his job, about 26 hours, and ate a lot of junk food on the ride. Consequently, his first week in paradise found him suffering from a quiet but uncomfortable intestinal disorder that sent him to a doctor in Anaconda on his first day off. When he got back, I made a delicate inquiry regarding the results of his visit and the state of his health. He said "I'll be fine. The doctor gave me a prescription for some suppositories". This was more information than I was really looking for, so I dropped the subject.

Two mornings later, I had a day off and George had to work. I was lounging in my bunk, and rolled over, opened my eyes, and began my day with the sight of George, shaving in his underwear, framed in the open bathroom door (ah, the romance of government housing). As I began toying with the notion of getting up and making coffee, I was horrified to see George, with the door still open, reach for his brown prescription bottle and extract from it a foil wrapped "silver bullet" of considerable diameter. I was on the point of screaming at him to shut the door, but before I could, he peeled off the foil wrapper, put the immense lozenge in his mouth, and choked it down with a large glass of water!


“George!" I shrieked "That's a suppository!"

"I know, the Doctor prescribed them for me."

"George! Do you know what a suppository is?"

"Yeah it's for constipation!"

An innocent! He had no idea.

"George! You're not supposed to swallow those Goddamned things!"

"What do you mean? What am I supposed to do with them?"

A fair question. When I answered it he, of course, assumed I was trying to play a disgusting practical joke on him. We had a ferocious argument that ended with the two of us standing together in the kitchen in our underwear, literally a half inch away from fisticuffs, looking at the entry for "suppository" in Webster's Collegiate. "You see that you fucking idiot, it says 'rectum'! Do you know where your rectum is?"

He went white as a sheet, called the doctor's office immediately, and asked if he had been poisoning himself. The doctor launched into a howl of laughter so loud I could hear it clear across the bunkhouse. When he calmed down, he told George they were just gelatin capsules full of glycerin, and essentially inert. George composed himself, shot me a murderous look and told me that if I breathed a word about what had happened, he'd kill me. I couldn't help it though, and I told Bart Miller that afternoon in the mercantile. By evening, George was known across the entire county as "Wrong End Nylund", a name that stuck until his appointment ended in the fall. He is locally famous to this day.

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AUGUST: A Fish Story

To the sportsman, Montana is a prodigal place. I came west from what is, arguably, the best trout fishing state in the East. I’d been a pretty dedicated fisherman since high school, and I knew how to do some business with a fly rod. At least I thought I did.

When Bob Miller found out I liked to fish, and had been catching a few nice brook trout in the little creek behind the station, he graced me with a hot tip. "The real nice ones are actually back in the beaver ponds, just east of where you've been fishin." "What's 'real nice' Bob?" "Well, I seen a few fish come out of there over 20 inches." Where I was raised, a brookie of 12 inches is a monster, and even taking into account the propensity for fiction common to all fishermen, Bob had me salivating. I didn't ask for any suggestions on fly patterns or tactics from Bob, since both he and his brother employed coarser methods than I was used to. When they felt like a little relaxation, they used worms or live grasshoppers fished on an old fly rod, like most local folks. There was also talk of Bart supplying the fixings for the big Miller family picnic and fish fry by plumbing the depth of a nearby lake with a quarter stick of dynamite. This technique, colloquially referred to as employing the “Dupont Coachman” fly pattern, was not something I had ever heard of back home, and Bart would neither confirm nor deny his expertise with it.

I'd never been in the beaver ponds before. They turned out to be full of mosquitoes, moose, and, based on the tracks, the odd grizzly, and were a perfect maze of channels, dams, ponds, meadows, and swamps. It was slow going and scary as hell. I stopped at what looked like a good spot at a breast high dam that held back a pond of perhaps an acre. I made a cast into the pond with a small deer hair dry fly affixed to a tippet of five pound test monofilament, a rig I often employed in eastern waters. There was boil at the fly that looked like someone had flushed a toilet out in the beaverpond, my rod bucked over double, and the fly instantly parted from the tippet with an audible "ping". I was left standing atop the beaverdam with line wrapped around my head, my eyes wide as saucers, and my knees knocking together, mumbling cusswords to myself. Later that evening I learned that the technical local angling term for this condition is "having your knickers up in a knot".

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As it turned out, I wound up living in Montana for seven years, and spent more time fishing than I probably should have. I return to fish and backpack nearly every year. I can't really say if the fishing is any better or worse than it "used to be", but it's different, I watched it change. Not long ago my brother-in-law called to tell me that he'd been looking at a People magazine at the barber shop and had read that fly fishing, a pursuit I've enjoyed since I was a teenager, was the number one trendy sport in the country. He had called me right away to tell me "You're so out of it, you're actually back in!" Of course this popularity has affected Montana's stupendous trout fishery in some fundamental ways.

While I wasn't in Montana for the "good old days" whenever that was, I can remember fishing the Madison, Yellowstone, Big Hole, Clark Fork, Bitterroot, and Kootenai rivers in the early 1980's, covering lots of water, catching sometimes obscene numbers of big trout, and often not seeing anyone all day. That doesn't happen anymore. The simple, impressionistic flies that used to work well have been replaced by much more exact copies of insects and baitfish, because many fish have been fooled by feathered hooks before, and they are more careful. People from California, Texas, and Back East have bought up and posted river frontage, especially in southwestern Montana, and eliminated public access to long stretches of some streams, hoarding the fishing for themselves, and turning what used to be working ranches into effete and nasty little "ranchettes".

These same newcomers have thrown their money and time at preservation of in-stream water flows, fighting whirling disease in the rainbow trout population, habitat restoration and preservation, and many other good things. Unlike many traditional Montana fishermen, they also tend to release most of their fish and to catch them with barbless hooks. All in all, maybe the good and bad effects on the "Big Name" rivers cancel each other out; the fishery remains healthy or even improved, but you share it with more folks.

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I returned to the beaver ponds the next evening armed with a much heavier tippet and, at the suggestion of my boss, some huge, gaudy, and delightfully old fashioned Potts “Mite” series wet flies. These native Montana patterns have collars woven from coarse hair, and are both seductive looking in the water and nearly indestructible. I had never used such flies and had no confidence in them, but they worked great. Over the next few weeks, I took several brook trout from those ponds that might have weighed three or even four pounds, real monsters, and even ate a couple. Their meat was pink like salmon, and just as delicious. Once, near the end of August, I was talking with Bob Miller in the station when a tourist walked in and asked me if the little creek and beaver ponds he'd passed driving up had any fish in them. I paused for a second and said "Just little ones and a few whitefish". When he left, Bob stared at me in mild surprise. "Damn, you're turnin into a real local ain't ya!"

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SEPTEMBER: Exodus

Abe let me know during the first week of the month that I'd be laid off in four weeks, and George went home the next week, leaving me the sole proprietor for the end of the season. One morning there was snow on the ridgeline above the Ranger Station, and for the first time in my life I heard elk bugling. The weather was beautiful those last few weeks, and the fishing was very good, but I was restless. Back in March and April, when I was plowing and shoveling snow, all I thought about was going home. Now I felt different.

I had learned so much in such a short time, as will happen when you're in your early 20's and don't know much to begin with. I had learned how to saw down and buck up a lodgepole without killing myself or anyone else. I learned how to properly cook a big brook trout. I learned how to saddle, ride, and be thrown from a horse. I learned what mountain oysters are, and that they make me sick. I learned how to roll my own cigarettes, and drink Rainier Beer. I learned that when you ask a girl from a town of 200 people to take a drive to Butte or Missoula with you, pretty much everyone knows about it by evening. I learned what Blue Healer dogs and Hereford cattle are. I learned to play shake-a-day with Fatty the barkeep. And I learned to love Montana.

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I ran out of work in October, and after having an end of the season dinner and debauch with the Miller twins and their spouses, I drove home to Pennsylvania in a used Ford pickup I bought over in Anaconda. It was cheap, but it needed work and would barely make 60 miles an hour. Consequently, the ride took almost five days, and I had lots of time to think. I thought that I had maybe seen the Promised Land, and like Moses, I was grateful for that. Over the tapping of the valves and the roaring from the rust hole in the muffler, I wondered if I would ever get back there.

311

Thankful

This is really just a short observation, a little less than one of my usual over-heated screeds, but too long for a social media post.

I had dinner with a couple wonderful young folks I am mentoring this summer. With us at dinner was a young man I mentored 17 years ago, with his four year old boy. I am Facebook friends with a guy I mentored in 1979, a grown man with grown kids who I remember as a teenager.


It has been my privilege to work with folks in their late teens and 20’s for more than 30 years. It has been a life’s work: still is. There are scores of them now. Some stayed in archaeology and preservation, and some moved on to wherever their opportunities and passions led. They are a remarkable and diverse slice of humanity, and for the most part they became wonderful people, colleagues, friends. I have been to many of their weddings, have consoled some of them at the loss of loved ones, held their children on my knee, and have witnessed in wonder as they accomplished great and beautiful things. I have watched so many young men and women stand on the edge of something, swallow hard, summon their courage, and leap, perhaps to falter just a moment, and then extend their wings and soar.


All I want to say is how humbled I am, and how grateful for this unlooked-for good fortune. To have played even a small role in that great act of bravery is an honor I’m not sure I ever deserved, and surely can never repay. I have been given a gift, and while maybe I was an unlikely recipient, at least I have the good sense to know it and to be thankful.

Most of you guys will never know how much I have learned from all of you, and how much I gained from your energy and courage.

But I know.

I promise to keep doing it until I fall apart at the seams, and I promise to try not to do that anytime soon. I’m having too much fun…

320

Advice

“Be careful about reading health books. You may die of a misprint.” Mark Twain

“There is nothing noble in being superior to your fellow man; … nobility is being superior to your former self.” Hemingway



Jim Harrison has written a wonderful poem with this title. You can read it here. It is much better than what follows.

Let me also say that I am getting right friggin tired of writing about my health, and I bet you are too. I’m going to write about other stuff soon. It’s just that I find myself thinking about folks who are in the same overloaded boat with me: low in the freeboard and in danger of drowning. What follows comes from a desire to be helpful. At least it’s not too long, and it’s heartfelt.

This morning I am 74 pounds lighter than I was the week before Christmas, and am settled into a pattern of weight loss that averages between two and five pounds a week. This hardly entitles me to preach. Every hour, every day, every week is a battle that I may easily lose. I have a long, long war ahead of me against an immortal and implacable enemy who might overcome me in the end. Still, it is good to be healthy and alive. Like the bright cardinal now perched above my bird feeder, I feel I have something to say.

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I work in a big bureaucracy, in a gigantic cubicle farm full of all kinds of people. One of them is an infamous gossip and busybody that most of my co-workers will do almost anything to avoid. A week or so ago, she stopped me in the hallway on my way to the lavatory.

“You’ve lost some weight!”

“Yes, I have.”

“What’s your secret?”

I thought to myself “What have I got to lose?” I wish that I was a better person.

“Well, first you must enter the hospital near death, and remain unconscious and close to expiring for two days. When you come to, you must have a large diameter hose of some sort rammed a good long way into every orifice in your body. You must also have two IV’s. Many of your family members and friends should be hovering over you, and it helps if they are reduced to tears. That should get you off to a pretty good start!”

She turned as white as a sheet, and I ducked into the men’s room and made my escape.

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If anyone tries to tell you that following this or that diet will have the pounds sliding off you without hunger or inconvenience, they are lying. If they are prescribing colonics, purges, fasts, exotic exercise regimens, magical garments, drugs and concoctions, and so on, they are selling you snake oil. If you are offered recipes for dishes that resemble a bale of hay, a chunk of plastic, or a length of board, don’t try them.

Here’s how it is. You must consume a very limited number of calories derived as much as possible from fresh and unprocessed sources. Most people need something like 2000 to 2500 calories a day to maintain a steady weight. I’m eating something like 1500 to 1300 calories a day right now. You must also engage in an hour or so of some kind of aerobic exercise very regularly.

You will be hungry a lot. That growling in your belly is your body burning stored energy in the form of fat. Those pangs are your friend. You will be sore from the unaccustomed exercise. That pain is your metabolism gearing up and repairing the minor damage you have done to your musculature, and in the process, burning more of that stored fuel. The entire process is challenging and difficult, but it works.

If you eat healthy food and not too much of it, and you exercise most days, and you do it for months, your weight will gradually decrease and you will become healthy. After you achieve your goal, if you continue to monitor what you eat, don’t eat junk, continue exercising, and regularly monitor your weight and health, you will remain healthy. You must do that, without relenting, until your last day. It never ends, but you will leave this world happier.

To pull this off, you’re gonna need to be motivated. That’s really the secret.

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Terror will only carry you so far, at most a couple-three weeks. What will sustain you is love. Your love for the people in your life who care for you will carry you. You must be honest with them, respect them, and not let them down. If there are no such people in your life, go find some. There are support groups and organizations filled with folks who have stood in your shoes and know your pain. Only the bonds of affection can save you.

I know you’re out there. I can feel your sorrow, your struggle, your courage. I extend my arms to hug you all tight. Whatever your demons, you can overcome them and send them back into the darkness. Please try. You are needed. The world would not be the same without you. 

347

No Way to Run a Railroad: A Rant

America's health care system is neither healthy, caring, nor a system.

Walter Cronkite


This isn’t going to be pretty.


I apologize in advance to anyone I might insult here, but I am very angry and what I’m angry about is an issue of some import to all of us. I also apologize for the length of this.


What follows are just opinions. I make no claims to extraordinary prescience. I have tried to do my research, so hopefully these opinions are more than just the product of bile.


They are also informed by personal experience.


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On a nice spring Saturday morning in 2004 I was doing some housecleaning. As part of the effort, I flipped the mattress over. As I pulled it up to my chest there was an audible POP in my upper left arm followed by a blast of pain in my bicep that left me laying across the mattress on my stomach, literally seeing stars.


On Monday I was at my doctor’s office. He examined the injured area and noted that the bicep might very well be partially detached. He said I needed an MRI to properly diagnose it. Imagine my (and his) surprise when my insurance company (then Blue Shield, now Highmark/Blue Shield) denied the claim, and instead suggested physical therapy. My doctor called them and appealed the decision, but they blew him off.


So I went to physical therapy for a month. Twice a week, the therapist massaged the deep tissue with ultrasound and with her fingers, and then had me perform a series of exercises and stretches. She, like the doctor, thought I had probably detached the muscle and didn’t think the therapy would do anything. It didn’t. My insurance paid for all eight sessions to the tune of several thousand dollars.


After the one month delay, they agreed to pay for the MRI, which diagnosed a detached bicep. A surgery was scheduled, which they also paid for. When I was awakened after the surgery, the doctor informed me that the muscle had retracted during the over one month delay before the operation, and he was unable to tug it back down and reattach it.


The injury is permanent, and I have lost much of the strength and stability I once had in my left arm.


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The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes.

The Commonwealth Fund “Mirror, Mirror On The Wall — 2014 Update”


By most empirical measures, America sucks at health care. We do have some great doctors, and we are innovative in developing treatments and medications, but those are about the only areas in which we excel. We spend more, die sooner, and are less healthy than all other comparable countries.


In 2014 the Commonwealth Fund looked at many aspects of health care in eleven of the world’s wealthiest countries and we rank damn near dead last in almost all of them.

 

Source:



http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror


The Institute of Medicine, one of the National Academies, agrees with this assessment.


http://iom.edu/Reports/2013/US-Health-in-International-Perspective-Shorter-Lives-Poorer-Health/Report-Brief010913


And even lefty publications like the Business Insider don’t have much good to say about the status quo.


http://www.businessinsider.com/us-health-lags-the-developed-world-2013-1


While the effects of the Affordable Care Act/Obamacare have at least led to more insured people, the cost of health care in America remains inordinately high, and all the other problems remain. Further, since so many of the newly available plans have high deductibles, for middle class and poor folks getting sick in America remains an excellent way to go into debt or at least to get poorer.


None of this is news. I just wanted to repeat it because people who live in an economy the size of ours ought to be absolutely enraged by it. There are people and companies in America who have become fabulously wealthy by trading on human misery and sickness, and among the victims have been our elderly, our children, the poor, the mentally ill, and the disabled.


It’s the sort of thing that puts people in the streets in other countries.


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Since my family doctor was out of town the second week of May in 2009, I was examined by a nurse-practitioner who carefully manipulated the red, hot and angry lump in my right calf. She looked worried.


“I think you have a DVT, a blood clot. You might have cellulitis as well. You need to have a venous Doppler examination right away, and you probably should be hospitalized.”


As this sank in, I asked her if she could call to have me admitted to the hospital and she explained that she couldn’t.


“I don’t have admitting privileges at any area hospitals. You’ll have to go to the emergency room.”


My first stop was the downtown city hospital emergency room, which had a line that literally extended out the door. I left for a suburban hospital. While the line was shorter, it was still a full house. So I gave them my name, described my symptoms, and took a seat. This was at roughly 5:30 PM.


I spent the evening watching the blue collar and poor of my community wait patiently and otherwise for their basic health care. Since none of these poor folks had coverage, their only recourse for a child’s earache, sore knees, a bad cold, etc. was the emergency room. A man with a janitor’s uniform sat across from me with his wife, a sick little boy and all the child’s siblings (child care, like health insurance being prohibitively expensive or simply unavailable). A waitress with the flu sat curled up in a plastic chair in the corner. A Serbian immigrant had brought his aged mother shaking with fever. We all waited, looked at magazines, and tried not to make eye contact.


By 11:00 PM I had a raging fever and my leg was throbbing and red above the knee. At 11:30 I was taken back into the EM. I had been there six hours. Had I stayed downtown it would have been worse. The EM itself was staffed by good and dedicated people, but it was chaotic almost beyond description. It had been a bad night, as it frequently is in many American hospitals. All the small cubicles were occupied and a few patients were on beds in a hallway. Some badly injured and/or gravely ill people had come in by ambulance, and some like me had walked in, and there were just too many sick people. I was given an IV of saline, administered an oral antibiotic, given an injection of a blood thinner, and since no beds were available in the hospital and I had not been ejected from a demolished car nor suffered a heart attack, at 2:30AM, I was discharged.


My phone being dead, and it being the middle of the night, I just drove myself home. Had the blood clot moved, or the sepsis not responded to the antibiotic, I wouldn’t be sitting here venting my spleen. The attending physician undoubtedly knew how risky it was to release me, but given the situation at the time, made a rational decision to do so. She simply had no choice in the matter.


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Almost nobody else does this. Almost everywhere else in the developed world, health care is, to one degree or another, paid for by the government. Anyone who tells you this is a perfect system is disingenuous or ill informed. Public sector single payer health care lacks some bells and whistles we are used to and would probably miss. T.R. Reid’s book and films on the issue note that hospitals in other countries are smaller and plainer than American hospitals. Medical equipment isn’t as cutting edge as it can be here, and gets used longer and harder. Testing and procedures that are elective or non emergencies takes longer to get scheduled. Doctors and other health care workers aren’t as well paid, although they still do OK. And of course, while you don’t get a bill from the doctor or hospital, it ain’t free. You pay higher taxes and those taxes pay for your health care. Depending on what data you look at, the Brits cough up more than 3 grand per capita to fund their system, the Canadians more than 4 grand.


All that said, nobody envies us. Whatever other folks pay in increased taxes pales in comparison to what we pay in premiums, co pays and deductibles. We drop more than $8,000 per person per year on healthcare; the highest in the world. For this we get lots of uncovered and insufficiently covered people jammed into emergency rooms, we get private policies with ruinous (i.e. multi-thousands) deductibles, we get health insurance providers that are primarily concerned with making money (including some that are supposed to be non-profits), we get health care CEO’s and Board Chairs who are multi millionaires, we get the world’s most expensive drugs, procedures, and medical devices, we get medical cost statements full of indecipherable gobbledygook and nasty expensive surprises, we get to be sicker and die younger than people in other developed countries.


We get shafted.


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I just wrote a check to a health care provider for 300 bucks. The bill they sent me itemized the many expensive charges Highmark covered when I had a lymph node biopsied back in October of last year, but one charge was not covered. It was for the anesthesia. So I called Highmark and spoke to a pleasant young man.


JB: “So why isn’t the anesthesia covered?”


Highmark: “Well, we don’t cover anesthetics unless they’re administered by an anesthesiologist. Yours was administered by the surgeon who conducted the procedure.”


JB: “I see. So why exactly don’t you cover anesthetics administered by a surgeon?”


Highmark: “Because that’s our written policy Mr Baker.”


JB: “No, I mean, what is the actual medical reason you don’t cover it?”


Highmark: “Oh, I couldn’t tell you Mr Baker, I’m not a doctor.”


The exchange, while at least mildly entertaining, wasn’t terribly enlightening. I called the health care provider next.


JB: “Were you aware this wasn’t covered unless an anesthesiologist administered the drugs?”


Provider: “No sir, but that’s not our responsibility. You signed a paper accepting responsibility for any uncovered medical expenses. Would you like us to FAX you a copy?”


JB: “No thanks, I don’t own a FAX machine. So is there any way I could have avoided this charge?”


Provider: “You could have declined the anesthetic.”


JB: “There was a guy waving a scalpel and a very large-bore needle around in between my legs. No anesthesia sounds like a bad idea.”


Provider: “Well that was your decision sir. If the invoice isn’t paid in 30 days, we’ll send it to a collection agency.”


Medical bills can be catastrophic, so in the big picture 300 bucks doesn’t seem too bad.


So why do I feel like I just got held up at gunpoint?


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In my opinion, we ought to have a single payer option of some kind here in the US, warts and all. I want this because it would be cheaper and simpler, but that’s not the only reason. In my opinion there are a few public concerns that should not be exposed to the ruthless efficiency of the market economy.


Competitive markets exist to make a profit. That’s hardly a bad thing. That’s what our national wealth is based on. My concern with exposing health care to the open market is value-based. I don’t think that turning a profit is always the primary public interest. Speaking for myself, I think the purpose of health care is to promote everyone’s health and to alleviate the suffering of sick people. The purpose of competitive markets is to make a profit. I’m not implying making a profit is immoral, but it frequently is a-moral. Making a profit in health care requires sick people. There is no real market incentive to have lots of healthy people who don’t pay to use the system. There is a real incentive for a publically funded system to promote health: it’s cheaper. It’s also morally defensible: a public policy based on empathy and decency.


Imagine that.


One of my conservative friends pointed out that a public single- payer system would decimate the health insurance, drug, and maybe even care provider industries as we know them. Good private sector jobs would disappear, as would investment income. That’s probably true. My only response is we’ve done that sort of thing in this country before, and we’ve survived it and become a better nation because of it.


Chattel slavery is a highly efficient and lucrative way to practice agriculture. Lots of people made lots of money off it. Sailing off to Africa and stealing people used to be a good job. We don’t do that stuff anymore for moral reasons, and there was great economic privation in parts of the antebellum South as a result. We did it anyway. As public values evolved in this country, holding people in bondage became intolerable, thank God!


Maybe comparing our current health care system to slavery is unfair. I don’t know. If someone wants to explain to me how making a pile of money off illness and misery is morally defensible, I guess I’m all ears.


Of course, given the way we govern ourselves these days, a sea change in public health care is just a pipe dream.


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In late December, not long before Christmas, I damn near died. I had been to my family doctor in November complaining about feeling tired and drifting off to sleep in odd places at odd times. She said “That sounds like sleep apnea. I’m going to schedule a sleep study for you.” A sleep study measures the dissolved oxygen in a patient’s blood and monitors the patient’s breathing while they are asleep. If sleep apnea is diagnosed, it can be readily corrected with a machine that pumps air into the patient’s mouth and nose while they sleep.


I didn’t hear from my Doctor’s office about the referral for a week, and the symptoms were getting worse, so I called. They hadn’t received an approval yet from Highmark for the sleep study. Weeks passed with no word from Highmark. On December 10th, the Doctor’s office called to tell me that Highmark had denied paying for the sleep study. Instead they would pay for a home study, i.e. one I would conduct myself with equipment they would mail me. The home study is much cheaper, apparently. This would be scheduled for December 19th. On December 10th, in the afternoon, I fell asleep at the wheel on the interstate, and wrecked my car, barely escaping with my life. After the wreck, the fatigue problem continued to worsen. I was rushed to the hospital on Sunday, in what turned out to be full pulmonary failure. Thanks to their denial of a diagnostic study, my friends at Highmark came really close to killing me twice in the same week.


I was unconscious Sunday night and Monday. I came to on Tuesday, and was placed on supplemental oxygen and was put on a C-PAP machine to sleep. My dissolved blood oxygen returned to a normal level (in the 90%+ range) from the dangerous levels I experienced (57%) when I arrived. I got out of intensive care on Wednesday. By Thursday morning I felt pretty darned good, good enough to ask the pulmonary specialist when I might be going home.


He chuckled and said “Not any time soon! Maybe Saturday…first we have to do the sleep study.”


I stared at him. “Huh? What sleep study are you talking about?”


“Oh we need to do one tonight so we can demonstrate to your insurer that you have sleep apnea and will require a C-PAP or Bi-PAP machine at your home.”


“But I almost freekin died on Sunday night! Doesn’t that count as proof?”


“Nope.”


“Why the hell not?”


“It’s not empirical.”


“What the fuck are you talking about? It’s empirical to me!”


“But not to Highmark my friend!”


And so that night I was wired up to a few monitors and told to go to sleep without the machine. I was awakened at about 4:00AM with a blinding headache. The nurses said they had collected sufficient data, removed the monitors, and put me back on the C-PAP. I went back to sleep and didn’t open my eyes again until about 11:00 AM. It took me until Saturday morning to recover, and I was finally sent home. My insurance company, having saved themselves a few grand by denying my doctor’s original request for a sleep study, incurred God knows how many thousands in costs for a week in the hospital, every penny of which they paid for. They also paid for my bi-pap machine, which now sits by my bed and keeps me alive.


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Ultimately, whatever changes I’d like to see in healthcare are more or less irrelevant. So are yours. That’s because it would require legislation.


In any deliberative legislative body in our country, or any country, it’s simply not possible to pass legislation that successfully addresses any large scale societal problem without goring somebody’s ox. Single payer health care would create winners and losers and would cost lots of money: money that would come out of somebody’s pockets. That would also be true of legislation that addressed the budget deficit, the Social Security shortfall, public education, pension reform, climate change, tax reform, energy policy, war and peace, poverty and income inequity, infrastructure, or anything else you would care to name. Real solutions require real change, real sacrifice, and real expenditures. Anybody who tells you otherwise is lying or dumb or both.


Our national legislature, all the state legislatures, and the national and state executive branches are all in a state of paralysis induced by money. If any of them profess support for any real solution to any real problem, the interests that might be hurt by the proposed solution go to work. Their money goes to the political opponents of those proposing the solution, and the solution goes nowhere. And that’s that. Our elections have turned into blizzards of cash. Officeholders and candidates spend most of their time raising funds, and the contributors quite sensibly expect something for their money. The result has been the extinction of truly transformative public policy, and that is dangerous.


The best any legislature or any leader can do these days is maybe kick the can down the road for a few years. People are pissed off and dissatisfied. A real plunge into disaster caused by inertia on the big issues could happen to us at any time, and that would create the conditions under which dictators and tyrants thrive. People like Hitler or Putin sell themselves as deliverers who will sweep away the do-nothings and accomplish big things. They wrap themselves in the flag, and identify scapegoats who have caused all the trouble. Desperate people vote for them.


Let’s not become desperate, shall we? The only way to change this short of armed insurrection is to vote for people who promise to get the money out of our elections and out of our legislative processes. Such people do occasionally run for office in all sorts of places. If they wound up in office in sufficient numbers, maybe they would do something about the problem. Last election cycle, about 40% of eligible voters showed up. For the other 60%, I have a suggestion. If you are wondering who is responsible for our cruddy health care system or for the rest of our other big and insoluble national problems, you need look no further than the nearest mirror.


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